Burch colposuspension

If you are considering having a Burch colposuspension or have one planned, it is important to know all you can about it. This includes:

why you need this operation

what it will be like

how it will affect you

what risks are involved

any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You are leaking urine when you cough, sneeze or run. This is called urinary incontinence. You may also hear it called ‘stress incontinence’.

What is a Burch colposuspension?

Urine is leaking from your bladder. A Burch colposuspension is an operation to lift the bladder neck into the correct position to stop the urine leaking.

The operation is called a colposuspension. Strictly speaking, the name means lifting up the uterus rather than the bladder neck, but the name has stuck. The operation was developed by a surgeon called Burch; hence the name Burch colposuspension.

What are the bladder and bladder neck?

The bladder is part of your urinary system. The urinary system consists of the following:

Two kidneys - The tissues of your kidneys make urine. This cleanses your body of waste fluids and chemicals. Your kidneys are about the size of your fist. They lie deep in your back just in front of your lowest ribs. You have one on the right and one on the left side of your body.

Two ureters - A ureter is a tube that carries urine from a kidney to your bladder. The ureter on each side runs down the back of your abdomen. They then run deep inside your pelvis, opening into the base of your bladder.

The bladder - This organ collects urine from both ureters.

The urethra - This tube goes from your bladder to the outside of your body. It passes urine from your bladder. The urethra opens to the outside just in front of your vagina.

Your bladder is a sac-shaped organ with muscled walls. It fills up with urine from your kidneys, through your ureters. You may feel the top of your bladder in your lower abdomen when it is very full. The rest of your bladder is in your pelvis, just in front of your uterus.

Your bladder and uterus lie on your pelvic floor. This is a sheet of muscle and ligaments stretching across the inside of your pelvis. You can feel it tighten when you try to hold urine in.

Urine drains from your bladder to the outside through a tube called the urethra. Your bladder neck is where your bladder joins your urethra. Your bladder neck and urethra also have muscled walls like your bladder.

The bladder neck and upper urethra normally lie above the pelvic floor. The lower urethra runs through the pelvic floor, as does the vagina. The urethra and vagina are very close together, with the urethra opening just in front of the lower part of the vagina.

Behind the vagina, the rectum also passes through the pelvic floor to the opening of the anus.

What has gone wrong?

When at rest, tone or tightness of the muscle in your bladder neck will normally prevent urine from leaking down your urethra to the outside. In cases of urinary incontinence, your muscle tone may not be enough to stop urine escaping when pressure in the bladder increases, such as during a cough. In healthy women, there is an equal increase in pressure to the bladder neck and upper urethra. This pressure squeezes the bladder neck and upper urethra shut and prevents urine from leaking.

If your bladder neck drops through your pelvic floor, the pressure of a cough may not fully close your bladder neck. Urine may leak through your urethra. This condition, with descent of the bladder, is called ‘true stress incontinence’.

Childbirth and the effects of the menopause can weaken the support for your bladder neck. Having a chronic cough, being overweight or having a heavy lifting job may also add to the problem. Weak support tissues may also let your uterus drop through your pelvic floor, causing a prolapsed uterus.

Are there other causes of incontinence?

Another common cause of urinary incontinence is a problem with the detrusor muscle of the bladder. To pass urine the detrusor muscle contracts increasing pressure within the bladder, the bladder neck opens and urine passes down the urethra. If your detrusor muscle is unstable it will contract at other times, causing incontinence. A cough or sneeze may make your detrusor muscle contract. This condition is called detrusor instability. Surgery to lift up your bladder neck will not help for this.

We use a special test called urodynamics to find out the cause of your incontinence. Sometimes the test shows that true stress incontinence and detrusor instability are both present. Surgery may not be the best treatment in this situation but sometimes it can help.

There are other causes for incontinence. We will need to rule these out before you decide to have surgery.

The aims

The aim of the operation is to lift your bladder neck into the correct position, just above your pelvic floor. This should give increased pressure to your bladder neck and upper urethra during a cough or other stress and prevent the leak of urine.

The benefits

You should no longer have problems with leaking urine. If the incontinence has disrupted your life, the operation should help things return to normal.

Are there any alternatives?

If your bladder neck has only dropped a little, you may be able to correct it with exercises to strengthen your pelvic floor muscles.

After the menopause, hormone replacement therapy (HRT) may improve the pelvic floor muscles enough to correct the problem and avoid the need for surgery.

Other surgical techniques can provide the same or a similar effect to a Burch colposuspension. The Burch colposuspension is considered to be reliable in most cases, with a success rate of about 85% (17 in 20). Other new procedures include a keyhole Burch colposuspension, stitching in a special tape called a tension-free vaginal tape (TVT) or injecting a strengthening chemical around the urethra, called a para-urethral collagen injection. These new techniques have yet to prove themselves fully but are developing all the time. Discuss all the options with your gynaecologist.

What if you do nothing?

If you do nothing your incontinence will probably continue and become steadily worse. However, the success of the operation is not guaranteed and it fails in about 15% (3 in 20) of cases. In most of these failures the incontinence is no better. In rare cases, the incontinence becomes worse.